I acknowledge and consent to the use of my photographic/video imaging footage in any and all publications, videos, and web pages created by Special Stars Performing Arts LLC. I waive any rights to compensation in any form. Special Stars Performing Arts LLC is not required to obtain my permission to reuse or republish photographic/video image footage in the future.

Yes: I grant permission for the use of my photographic/video imaging footage.

No: I do not grant permission for the use of my photographic/video imaging footage.

Liability Waiver *

I/we realize that participation in performing arts classes and activities could involve some possible personal injury. Despite all precautions, accidents and injuries may occur. Any student may decline to participate in any activity which may be harmful. By signing this release form, I/we (the student and parent/guardian) assume all risks related to the use of any and all spaces used by Special Stars Performing Arts LLC. Should the student require medical treatment as a result of an accident or illness arising during activities, I/we consent to such treatment and agree to be financially responsible for any medical bills incurred as a result of emergency medical treatment provided.
I/we agree to release and hold harmless Special Stars Performing Arts LLC including its owner, volunteers, classmates, and facilities used from any cause of action, claims, or demands now and in the future. I/we will not hold Special Stars Performing Arts LLC or its volunteers liable for any personal property damage/loss or personal injury, which may occur on or off the premises before, during, or after classes and/or performances.
I/we understand that Special Stars Performing Arts LLC is an insured entity. In the event that I/we should observe unsafe conduct or conditions before, during or after my/our classes, I/we agree to report the unsafe conduct or conditions to the owner or volunteers as soon as possible.
I have read, understood and agree to be bound by the above statement from Special Stars Performing Arts LLC.

I have read, understood, and agree to be bound by the statement from Special Stars, LLC.

Student's Name

Student's Name

First Name

Last Name

Parent/Guardian Name

Parent/Guardian Name

First Name

Last Name

Parent/Guardian E-signature

Parent/Guardian E-signature

First Name

Last Name

Date

Date

MM

DD

YYYY

Thank you!

STudent Profile Form

Name *

Name

First Name

Last Name

Disability

He/she loves the following:

What sort of things upset him/her?

Are there any activities that calm him/her down if feeling overwhelmed?

What behavior strategies work best with him/her?

Please provide us with any additional information you would like us to know about.

Thank you!

PARTIAL Scholarship Application

Special Stars has a non-profit organization dedicated to helping those in need of partial scholarships. These scholarships DO NOT cover programs in their entirety, but do help reduce costs. Please remember that scholarships are a gift and should not be expected every time you apply.

Student's Name *

Student's Name

First Name

Last Name

Parent/Guardian Name

Parent/Guardian Name

First Name

Last Name

Email Address *

Phone

Phone

(###)

###

####

How many activities do you partake in weekly and what are they?

Have you gone through eligibility with DDS?

Yes

No

Do you have an allocation through Fidelity House?

Yes

No

Do you use food stamps?

Yes

No

What can you contribute towards the session?

$

E-signature *

E-signature

By signing below, I agree that all information above is true and honest to the best of my knowledge.

First Name

Last Name

Date

Date

MM

DD

YYYY

Thank you!

PLEASE NOTE: All applicants will be contacted within 2 weeks about whether or not their application has been approved.